Provided herein are systems and methods related to transabdominal access to various internal regions, including the gastric environment, from outside the body. The systems are particularly useful for securably positioning a cannula through the abdominal wall to facilitate access to the gastric environment from outside the patient body. The systems and methods are versatile, providing a platform for intraluminal gastric access, extraluminal gastric access, and/or access of the peritoneal space and related organs using a single or multiple systems. Multiple systems may be used to provide simultaneous access via different cannula locations relative to the stomach lumen and peritoneal space, such as to provide simultaneous access to the intraluminal and extraluminal environment. The systems and methods are compatible with any number of medical instruments, including conventional laparoscopic and endoscopic instruments used in surgical procedures.
There are significant and ongoing developments in the field of minimally invasive surgery, where substantial surgical procedures are conducted with relatively minimal trauma to the patient body. For example, endoscopic procedures access a patient's internal regions via introduction through the patient's mouth to the gastrointestinal region, thereby avoiding a need for an externally located incision. Similarly, laparoscopic procedures access other regions via a relatively small incision through the abdominal wall to the peritoneal cavity. In this manner, endoscopy provides a physician an intraluminal ability to diagnose and treat gastrointestinal (GI) tract abnormalities. In contrast, laparoscopy provides a physician an extraluminal ability to diagnose and treat GI tract abnormalities. Accordingly, there is a need in the art to reliably combine both intraluminal and extraluminal ability in one platform in a manner that is easily used, reliable and robust.
Endoscopic procedures are limited in that the devices must be able to be inserted through the esophagus without causing undue irritation. This, therefore, inherently constrains the number and size of devices that can employed. Furthermore, it can be difficult to reliably control and position multiple endoscopes to specific locations. For these reasons, endoscopic procedures tend to be relatively simple with one endoscope and confined to the upper GI tract, generally the esophagus, stomach and duodenum so as to avoid increasing risk of complications.
Because of the inherent limitations of endoscopic procedures, laparoscopic procedures are also used for introduction of a medical instrument through the abdominal wall, thereby accessing the body extra-luminally. In contrast to an endoscopic procedure where an instrument is introduced through the mouth, laparoscopy requires an opening be made through the abdominal wall for medical instrument access to the inside of the patient, such as the intraperitoneal space. This is typically achieved by using a trocar or other instrument having a sharp distal tip and a passage to provide a working passage for a medical instrument. Those trocars, however, suffer from inherent disadvantages and associated risks. First, the peritoneal membrane must be actively punctured from outside the patient to provide instrument access. This can result in increased risk of infection or other complications. Second, it can be difficult to reliably secure the trocar or other cannula-type element, including for extended periods of time with attendant movements on the trocar from instrument use during the surgical procedure. Lack of a safe, stable, and reliable working channel that traverses the abdominal wall can lead to unwanted complications. Furthermore, current technology requires that if a laparoscopic physician wishes to place a trocar into the gastric lumen via standard laparoscopic technique, they must make multiple abdominal incisions which will allow them to grasp the external wall of the stomach and then fix it to the abdominal wall by multiple suture/staple or other fixation methods. Once the stomach has been fixed in a safe and stable manner, the physician must make an external full thickness incision through the gastric wall and then externally place a surgical trocar that can be used for both passage and manipulation of laparoscopic instruments into the gastric lumen. The trocar must be air-tight to allow air insufflation of the stomach for both internal vision as well as manipulation of instruments. Trocars usually have internal air-tight seals for passage of instruments. The surgeon, however, must ensure an air-tight seal around the external aspect of the trocar to prevent air leakage on an external surface where the trocar contacts the gastric wall. This procedure is complex, with an attendant risk to establish intra-gastric access via laparoscopic surgery, and reflects the inherent difficulty in trocar insertion into a non-solid organ, such as a stomach wall.
For at least these reasons, there is a need in the art for improved abdominal wall ports that provide a work platform through which one or more medical devices are inserted, while avoiding the risks and drawbacks of conventional trocars that are inserted in a direction from the patient skin surface toward and through the peritoneal membrane. In particular, current methods and devices do not allow for an intra-gastric trocar to be placed in a retrograde method which can provide simultaneous access to the lumen of the UGI tract as well as the intra-peritoneal space/organs. The systems provided herein address these problems in a safe, reliable and easy to implement manner, such as by a unique introducer in combination with a cannula that facilitates retrograde introduction to a patient.